As acronyms go, it’s the tits-up PITTs, but for many concerned about the NHS, it is a pile of shit. Presented as a partnership, TTIP – the Transatlantic Trade and Investment Partnership – is, depending on your point of view, either a sensible deregulation of transatlantic trade and investment that will free up a few extra bob for the folks back home, or Ernst Stavro Blofeld writ large, hell-bent on a grim SPECTRE TM – much more of this, and Dr No will need treatment for acronymitis – of corporate world domination at the expense of the nation-state. At the crux for health care is a TTIP proposal to allow private capital to sue sovereign states in ‘ad hoc’ tribunals for loss of profit. Claims of this sort have already happened under other trade agreements: in Europe, the private Dutch health insurance company ACHMEA recently sued Slovakia after a new government introduced a more socialised health service that threatened ACHMEA’s profits. The outcome appears for now at least to be in Slovakia’s favour: the tribunal said it had no jurisdiction – ‘the design and implementation of its public healthcare policy is for the State alone to assess’ – meaning, in effect, ACHMEA had lost.
So far, so good: nation-state: one, multi-national corporation: nil. But, on a global scale, ACHMEA and Slovakia are minnows tiddling in a local pool. TTIP, on the other hand, is transatlantic, taking in Europe and America, and can be said truly to be global. If TTIP comes in without a public health service exemption, it won’t be European minnows swimming across the Pond, but American sharks, turning the once calm blue waters of the NHS into a foaming red frenzy of feeding.
The question of will TTIP lead to business as usual for the NHS or a foaming red bloodbath appears therefore to rest on whether public health services will be excluded from the agreement. Security services, for obvious reasons, are routinely excluded from such trade deals, and so typically are public health services, which is – presumably – why the government is saying no specific NHS exemption is needed. But then there’s the Act we love to hate – the Health and Social Care Act 2012, which downgraded the Secretary of State’s duty to provide to duty to promote. This muddies the waters, such that it is now difficult to see whether they be minnows or sharks circling in the deeps.